Eyes And Brow

The eyes, or more appropriately the periorbital, or area around the eyes, is the first area that shows facial aging. As we age, we have a subtle descent of the outer part of our eyebrow which starts to appear in the form of hooding of the skin of the upper lids. Brow descent (known as brow ptosis or brow lowering) continues in conjunction with excess skin developing in the upper lids.

What we normally notice early on, in addition to the lateral hooding, is the fact that we develop forehead lines. The reason behind us developing forehead lines is that we are sub-consciously trying to raise the brow from it’s lowered position. (This is why many people when having anti wrinkle injections to their forehead feel a degree of heaviness to their brow and may notice a lowering of their brow at the same time as their wrinkles improving)

This is why when anyone comes to see me about their upper eyelid skin excess, it is crucial for me to study their brow at the same time. I then often need to discuss with them the subtle interplay and interaction between the brow position and their eyelids. Whilst in over half of my patients upper eyelid surgery (upper blepharoplasty) alone will achieve an excellent result, a significant minority of my patients will achieve a sub-optimal result if their brow is not addressed at the same time. However, this does not mean that every patient with some brow involvement needs to have a brow lift (an endoscopic brow lift, a lateral temporal lift or a direct brow lift). Sometimes, treatment with botulinum toxin (e.g. Botox) will achieve a “chemical brow lift”. That said, it is important that every person understands how their brow might be involved in the appearance of their upper eyelids, so that they can appreciate any limitations of surgery without readjusting the position of their brow and can understand that surgery to their brow may be indicated at a later date, if not undertaken at the same time.

Upper Eyelid Lifting

An upper eyelid lift on it’s own is a procedure I perform week in week out under local anaesthetic at Purity Bridge. It is a relatively simple procedure that can produce a very subtle natural and fresh result without any appearance that someone has undergone surgery. This explains it’s continued popularity and increasing number of requests that we are seeing. It involves removal of skin and sometimes a small section of muscle and occasionally fat from the upper eyelid area. Once completed and stitched, tapes are kept on for a week until the stitches come out. Most of the bruising settles by the end of the following week.

Surgery to the Eyebrow

Broadly speaking surgery to the eyebrow can be carried out remotely (with scars in the hairline) or directly (with scars sitting just within the upper hairs of the eyebrow). There are pros and cons with both approaches. Scars kept hidden within the hairline in an endoscopic brow lift are clearly more discreet, however, being more remote from the target area of elevation (the eyebrow itself) means that there is a degree of loss of ability to exert the same amount of pull as when the elevation is taking place at the site of the eyebrow. An endoscopic browlift is performed under general anaesthetic normally as a day case procedure.

A direct browlift can be performed under local anaesthetic but does leave a scar that might be somewhat more visible as it is within the upper hairs of the eyebrow. However with advances in techniques the scars we are achieving are better and better. Furthermore, particularly in men who do not have hair to hide the scars of an endoscopic browlift, arguably the scars in the upper border of the eyebrow are a far better approach allowing direct elevation of the brow with scars that, if they are visible, may appear to be natural forehead creases.

The compromise between the two is a lateral temporal lift. This is normally performed under general anaesthetic and can help to elevate the outer portion of the brow to a more youthful position which at the same time opens up the outer border of the eyelid and addresses the lateral hooding in this area. It is an excellent procedure in conjunction with an eyelid lift and also with a facelift. The reason it is so good with a facelift is that it can also help to re-distribute the tension and the skin pleating that can occur in the temporal region once the skin is being stitched in. This can be discussed with you at the time of your consultation if need be.

Maintenance

Maintenance of any eyelid lift or brow surgery is highly advisable. The fundamental non-surgical treatment for maintenance is the use of anti-wrinkle injections (botulinum toxin, also referred to as Botox) to maintain the elevation of the brow but also address fine lines and wrinkles in the area around the eyes.